Primary City/State:
Phoenix, Arizona
Department Name:
PHSO Admin Dept
Work Shift:
Day
Job Category:
General Operations
The Chief Health Services Officer serves as a pivotal executive leader responsible for shaping the strategic direction, operational excellence, and clinical performance of Banner Health's Insurance Division. This role offers the opportunity to influence the health outcomes of a diverse and growing membership population while leading one of the most comprehensive health services organizations in the region. The leader will be charged with advancing innovative programs that improve member health, elevate care quality, and support sustainable growth across Banner's health plans and administrative services organization (ASO).
Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.
Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona''s largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY
This position directs the operations of the health services department of the Administrative Services Organization (ASO) including prior authorization, utilization management, program training and development, pharmacy technicians, care and case management, integrated care, behavioral health services and transplant coordination. The health services department is responsible for the day to day operations required to meet the standards governing the availability of services within the various Plans according to AHCCCS, Arizona Administrative Code, AZ Department of Insurance, CMS Regulations and payer delegated duties to Banner Health
CORE FUNCTIONS
Leads the strategy and direction of health services operations, assuring efficient and effective use of people, services and technology ultimately impacting positive financial and clinical outcomes. This includes developing and implementing strategies that support health services programs focusing on member care services, health improvement and quality outcomes. Strategic development, oversight and leadership of the Health Services Department, advancing the programs provided by Health Services to manage the membership of the Insurance Division programs and Plans.
Works with the Chief Medical Officer, the medical directors and other medical management staff in making recommendations for operational changes to meet, maintain and improve operational efficiencies and to meet/exceed these regulatory standards. Identifies areas amenable to optimizing use of Insurance Division Funds. Collaborates with the CMO and the Medical Directors to develop and implement programs to achieve such positive health outcomes while maintaining quality.
Oversees the operational execution of all the clinical care management programs within the ASO (Maternal Child Health, Behavioral Health, Care and Case Management, Pharmacy, Dental Services, Utilization Review, Concurrent Review and Transplant Coordination) in conjunction with Medical Directors.
Collaborates with members of the ASO senior leadership team to direct the health services operations to achieve cost containment and control within the limits of the standards and optimize available resources for a high performing efficient clinical administrative unit.
Provides executive sponsorship and oversight in the development of operational policies, procedures and/or guidelines, which impact on the delivery of quality of medical care. Directs the operationalizing of medical policy, protocols or guidelines.
Ensures compliance with state and federal regulation across all health service operational units, including access and provision of medical care.
This position has accountability for ensuring the success of the organization, including setting the strategic direction and providing strong, innovative, thoughtful and creative leadership in the achievement of the organizations strategic goals and objectives. This position requires the skill to negotiate. Customers of this position are both internal and external, including leadership, staff, medical staff, regulatory agencies, and the community.
MINIMUM QUALIFICATIONS
Must possess a strong knowledge in management as normally obtained through the completion of a master's degree business, healthcare or related field, coupled with five or more years of increasingly responsible administrative leadership experience in an integrated administrative services environment or large multi-operational, complex environment.
Seven years of director level experience in healthcare management, with at least five years of experience in either managed care utilization, case or a quality management leadership role, is required. Must have knowledge of clinical and operational quality improvement processes. Must have knowledge of the requirements of national/state accrediting agencies, such as NCQA, HEDIS, Medicare (CMS) and Medicaid (AHCCCS). Experience in Medicare and Medicaid managed care clinical and utilization management is required. Must be able to demonstrate successful experience and program development/improvement in health plan clinical management. Experience in Medicare/AHCCCS Compliance programs is desirable. Proven track record of partnering with providers, community and organizational leaders to achieve desired organizational outcomes. Proven experience in leading fiscally sound, profitable, efficient, and responsible healthcare operations. Strong financial and business acumen, including a keen understanding of operational and financial measures that define success, as well as budgeting and forecasting methodologies, including working knowledge of capital planning and capital investment practices. Knowledge of emerging trends in quality and member safety. Skilled in coaching and developing direct reports and/or other employees that results in enhanced performance outcomes; setting and pursuing aggressive priorities and goals that demonstrate a strong commitment to overall organizational success; effectively allocating resources in order to accomplish goals and objectives; assessing and assimilating facility and industry financial dynamics in order to act quickly and appropriately to changing environmental factors; negotiating win-win scenarios with outside vendors/partners while representing the Insurance Division products, partners, and organization in the best possible light; developing collaborative and positive relationships with providers, regulators, employees, volunteers, the community, and/or other applicable parties; measuring and managing work outputs. Excellent human relations, organizational and communication skills are essential. Leadership style and characteristics necessary to effectively perform in this role include: strong work ethic; results-oriented; persuasive; motivational; able to make rational decisions in difficult situations; inspirational; honorable; confident; systems-thinker; innovative; life-long learner; courageous; high-energy; integrity; collaborator; ability to work with teams; good listening; nonvolatile; values multiple disciplines; community visibility and leadership; and passionate about continuously improving and providing high quality care and service excellence to members, families, employees and providers.
PREFERRED QUALIFICATIONS
A current licensure as a registered nurse in the State of Arizona is preferred.
Additional related education and/or experience preferred.
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